Without dedicated professionals like Dr Rama Ragupathy you wonder where general practice might be.
He wanted to keep on working until he was 80, but has been prevailed upon to retire in August, aged 78.
Dr Ragupathy has a simple explanation for why he has kept treating people far beyond the traditional retirement age: "I wanted to serve the people."
It is a sentiment which health administrators wish more doctors would take to heart.
The Royal New Zealand College of General Practitioners has long warned that the ageing population would bring with it a shortage of doctors, and has published several workforce surveys in the past decade in an attempt to underline its point that there is already a workforce crisis.
The latest, published earlier this year, underlines that point and contains a dark warning that 50% of all GPs intend to retire sometime in the next decade, and questions where their replacements will come from.
"The proportion of specialist GPs intending to retire within the next two years has increased steadily year on year, rising dramatically from 4% in 2014 to 14% in 2020."
Numerous obstacles stand in the way of a fully staffed GP workforce.
Not enough of New Zealand’s trainee doctors want to become GPs, instead eyeing up the usually more financially lucrative fields of specialist practice.
That has meant the country has looked overseas to fill those gaps — Dr Ragupathy worked in Sri Lanka and Nigeria before moving to New Zealand — but there is a worldwide shortage of GPs and competition is fierce to hire them.
At least one southern practice has in recent times hired an overseas recruit only for them to opt instead for a bigger pay packet in Australia, and finding a clinician like Dr Ragupathy, who decided to put down roots in Dunedin and served his community for more than 24 years, is no easy task.
Otago and Southland not only have to compete with the financial lure left out to entice GPs, but the largely rural regions also have to strenuously sell the lifestyle the region affords its residents as opposed to the bright lights of the big cities.
WellSouth, the regional primary health organisation, aids a network of 81 general practices, spread from Kurow and Twizel in the north to Bluff in the south.
Its medical director, Carol Atmore, is a GP herself and all too aware of the challenges practices face in recruitment, and the importance of general practice if the integrated health system intended for the future is to actually work.
To that end, WellSouth already had several initiatives in place to bolster its GP ranks, she said.
Those included supporting practices to meet the new Immigration New Zealand settings for assisted migration and supporting four clinics to take second-year junior doctors on three-month placements.
"We want to expose them to what being a GP is all about, because there’s really good international and New Zealand evidence that if young medical students spend time outside of hospitals in those formative years then it definitely has an impact on their decisions about where they want to work further down the track," Dr Atmore said.
"We are doing a test run this year with those four practices and 15 junior doctors across Otago and Southland, and some of them have already signed up for GP training."
As the workforce report notes, hospital-based training is fully funded for a specialist’s full training period, a financial break not enjoyed by trainee GPs.
Combine that with the lack of pay parity between GPs and other medical doctors, and general practice has a great deal of ground to make up.
"To train a further 100 GPs, a minimum of a further 100 general practices will be required to agree to taking on the training of a first-year registrar," the report said.
"Do the current training arrangements provide the right incentives to attract the extra registrars and the practices required to host their postings?"
While four potential GPs might seem small, it is a start, and Dr Atmore points out that WellSouth also supports and hosts the college’s GP training programme and workshops.
"People are more likely to take up practice where they train, and there are other ways that we are supporting the general practice team because it’s not all about doctors. There are nurses, clinical pharmacists, administrative staff and healthcare assistants as well."
"We all hear the conversations that it’s tricky but we also need to reimagine this and look at the opportunities that the health system review is presenting to us and all keep working together."
Doctors like Dr Ragupathy, who came south and chose to stay, are rare but valuable commodities.
The key to finding them and retaining them was budding doctors realising general practice had rich rewards beyond simple financial recompense, Dr Atmore said.
"They love their patients and the relationship that they build with them over time and you don’t get that in many other parts of medicine and it’s a really special part of being a GP . . . that’s what I love about it."
